Restorative efficiency: How these leading dentists save time without sacrificing quality of care

Think about the procedures you do every day in your dental practice. Picture that last bread-and-butter class II composite. I’d bet you were operating somewhat on autopilot. When we do common restorative dentistry, we enter into what psychologists call a “flow state”; we get in the zone. It comes with great experience and is a sign of mastery.

If there is one downside of being in the flow with restorative dentistry, it’s that we can get too accustomed to doing things the way we did them yesterday. “If it ain’t broke, don’t fix it,” right? Even if we get a little bored from time to time, we might be afraid of making changes to our routine that could compromise patient outcomes. So, we tend to stick with what we know.

But materials evolve. New techniques are discovered. It’s arguably a disservice to our patients if we perform dentistry the exact same way we did a decade ago, ignoring the efficiencies or improved outcomes that could be realized. Getting out of our comfort zone now and then is a good thing.

My favorite way to safely introduce new materials and techniques into my practice is to observe what the thought leaders in our profession are doing. I’ve invited some of the sharpest minds in restorative dentistry to share their favorite tips and tricks with us. These key opinion leaders are continually testing new approaches to even the simplest of procedures. They’ve shortened the learning curve and are sharing what works best in their hands. Join me as we look over their shoulders to see how they tackle everyday dentistry efficiently.

Pamela M. Maragliano-Muniz, DMD, FACP

I remove amalgam restorations almost every day. It’s common to identify areas of unsupported tooth structure after the amalgam and any secondary caries are removed. It’s important to use caution when blocking out these undercuts, as some composites and techniques can create stress. These stresses can then increase the risk for fracture of these areas or reduce the longevity of the restorations. Fiber-reinforced composite restoratives can reduce the risk for crack propagation and are an excellent solution to reinforce undercut, undersupported tooth structure. everX Flow (GC America) has excellent handling and fracture toughness and has become a material that I reach for to reinforce direct composite restorations and when building up preparations for indirect restorations on vital and endodontically treated teeth. There is a dentin shade that must be applied in 2 mm increments and a bulk shade that can be applied in increments up to 5.5 mm. The use of fiber-reinforced composites

helps to create efficient restorations and improve long-term outcomes.

Howard S. Glazer, DDS, FAGD

wo of my favorite procedures are direct resin veneers and direct resin restorations. To perform these procedures efficiently and reliably, I rely on the OptraSculpt Pad and Instrument Kit from Ivoclar Vivadent. Both the anterior (gray handle) and posterior (black handle) instruments, along with their disposable tips in various shapes, allow you to sculpt and contour composite without the composite sticking to the instrument. And there is no pullback when placing the composite in the deepest portion of the cavity preparation and leave your surfaces about 95% finished and polished.

Joshua Austin, DDS, MAGD

I hate two class IIs back-to-back. It’s a situation that happens often but it’s frustrating. I have found the best way to do this efficiently and well is to restore them together. I prepare both teeth together; then I use the Garrison 3D XR system. I put a matrix band on each tooth with a wedge in between and then the ring to hold both bands on. I restore one tooth first. After the first tooth is done, I take off the ring and take out the matrix on the tooth I restored first. Then, I put the ring back on, recontour the matrix on the second tooth, and restore it. This is far more efficient than restoring one tooth at a time and gives me a much better interproximal contact.

Ian E. Shuman, DDS, MAGD

Creating anatomy and adjusting posterior occlusal surfaces can be challenging. Physical access and the formation of a surface with correct form and proper function are often difficult. These problems can be solved using my favorite shaping and finishing burs, the Occlusinator Pro system (Strauss Diamond Instruments). The long angular shape of the Xmas tree creates gentle slopes and smooth transitions, the acorn burs in the large and medium sizes create anatomical grooves, and the small acorn bur allows you to adjust the smallest of occlusal interferences. The burs also have a built-in safety; a polished segment means no overcarving or damage to the enamel.

Stacey L. Gividen, DDS

My favorite clinical tidbit that I love sharing and encouraging my colleagues to try in their clinical practices (and it’s nothing new!) is the buccal PDL infiltration of 4% Septocaine 1:100 k epi for lower first and second molars. I can count on one hand how many times this last year I’ve given a mandibular block. This technique works amazingly well, my patients prefer it because their entire jaw isn’t numb, it’s less painful than the block, fine-tuning the bite is easier, and its application is across-the-board—from extractions to resins to my hygienists using it for those fun 1–3 SRPs. I’ve posted a video on how to do it on DentistryIQ. Check it out at this link and give it a go. What do you have to lose?

Clinton Timmerman, DDS

I really like the Bioclear system for class II restorations. The matrices are clear,

allowing the curing light to pass through easier, and the clamps and wedges are user-friendly. Flowable composite followed by warm, injectable, packable composite helps prevent any voids and ensures the composite reaches each nook and cranny. For isolation, I prefer the Isolite or Isodry. There are comparable systems that are great, but the concept of a bite block, suction, and, in some cases, a light built into one makes it simple to keep the working area easy to access, isolated, and keep the tongue and cheeks out of the way. It is also easier to access areas near the gingiva as opposed to where a rubber dam or rubber dam clamp may get in the way. Even though the units are for single-use only and cost more than a rubber dam, the increased expediency and decreased stress of an Isolite makes it worthwhile.

Erin Elliott, DDS

We recently had a soon-to-be dental student observing in our office. I love having a chance to show a behind-the-scenes look at real-world dentistry and efficiencies that I know she won’t be getting in dental school. Just this past week, I held up my handpiece and showed her the bur I was using. I said, “If dental school doesn’t supply you with these, then buy them with your own money. I can’t live without it.” And I’m not even a prima donna. The Premier Two-Striper 201.3 Interproximal Trimmer has a piece of my heart. The patented diamond bonding technology eliminates peeling and dulling. The shape allows me to use it to clear my contacts in class II and class III fillings, bevel the enamel and finish the filling in class V composites, and finally trim the flash IP and shape embrasures in class II filling. Just trust me.

Editor's note: This article appeared in the August 2021 print edition of Dental Economics.